Sun Mengchun, Li Chaochao, Su Tianqi, Tao Benzhang, Gao Gan, Wang Hui, Yu Xinguang
School of Medicine, Nankai University, Tianjin, China.
Department of Neurosurgery, the First Medical Center of Chinese PLA General Hospital, Beijing, China.
Neurosurgery. 2025 Jul 7. doi: 10.1227/neu.0000000000003618.
Although plenty of evidence supports the effectiveness of sacral neuromodulation (SNM) in improving urination and defecation, few studies concerned its effect on the patients with spinal dysraphism (SD). This study aimed to evaluate the effects of SNM on SD-induced neurogenic bladder and bowel dysfunction.
We prospectively followed the patients with SD who underwent SNM in our department from May 2019 to June 2024. Fusion images of sacrococcygeal computed tomography and magnetic resonance sacral plexus nerve images were used as essential references for preoperative evaluation and intraoperative implantation. Patient's subjective improvement by ≥50% from baseline was defined as implantation procedure success. Among the included patients, urodynamics, urinary ultrasonography, daily urination frequency, daily urine leakage, and neurogenic bowel dysfunction score were compared before and after SNM and between unilateral and bilateral SNM.
A total of 44 patients were included, of whom 97.73% reported improved symptoms and 47.73% achieved implantation procedure success. SNM significantly improved the average postvoid residual volume, maximum cystometric capacity, bladder compliance, daily urination frequency, daily urine leakage, and neurogenic bowel dysfunction score. We found a significantly higher success rate in the patients stimulated bilaterally compared with those stimulated unilaterally but no intergroup differences against age (between minors and adults), sex, lower urinary tract symptoms, and intestinal symptoms. Bilateral SNM performed significantly better in improving postvoid residual volume, daily urination frequency, and daily urine leakage than unilateral SNM. No SNM-related complications were reported during follow-up.
SNM can improve urination and defecation in the patients with SD safely and effectively. We strongly recommend fusion imaging of sacrococcygeal computed tomography and magnetic resonance sacral plexus imaging as a valuable and promising technique for preoperative evaluation and intraoperative implantation. A flexible implantation strategy involving electrode location and number helps achieve ideal modulation effects in the patients with SD.
尽管有大量证据支持骶神经调节（SNM）在改善排尿和排便方面的有效性，但很少有研究关注其对脊髓脊膜膨出（SD）患者的影响。本研究旨在评估SNM对SD所致神经源性膀胱和肠道功能障碍的影响。
我们前瞻性地随访了2019年5月至2024年6月在我科接受SNM的SD患者。骶尾骨计算机断层扫描和磁共振骶丛神经图像的融合图像用作术前评估和术中植入的重要参考。患者主观改善程度较基线提高≥50%被定义为植入手术成功。在纳入的患者中，比较了SNM前后以及单侧和双侧SNM之间的尿动力学、泌尿系统超声检查、每日排尿频率、每日尿失禁情况和神经源性肠道功能障碍评分。
共纳入44例患者，其中97.73%报告症状改善，47.73%植入手术成功。SNM显著改善了平均排尿后残余尿量、最大膀胱测压容量、膀胱顺应性、每日排尿频率、每日尿失禁情况和神经源性肠道功能障碍评分。我们发现双侧刺激患者的成功率显著高于单侧刺激患者，但在年龄（未成年人与成年人之间）、性别、下尿路症状和肠道症状方面无组间差异。双侧SNM在改善排尿后残余尿量、每日排尿频率和每日尿失禁方面比单侧SNM表现明显更好。随访期间未报告与SNM相关的并发症。
SNM可安全有效地改善SD患者的排尿和排便。我们强烈推荐骶尾骨计算机断层扫描和磁共振骶丛成像的融合成像作为术前评估和术中植入的一种有价值且有前景的技术。一种灵活的植入策略，包括电极位置和数量，有助于在SD患者中实现理想的调节效果。
